Provider Demographics
NPI:1235289760
Name:BONK, WILLIAM F (LVN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:BONK
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 RICHLAND AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1359
Mailing Address - Country:US
Mailing Address - Phone:323-664-6727
Mailing Address - Fax:
Practice Address - Street 1:1111 W 6TH ST STE 111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1823
Practice Address - Country:US
Practice Address - Phone:213-482-6400
Practice Address - Fax:213-482-6408
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN172518164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841342318Medicaid
CA1265620183Medicaid
CA1306922554Medicaid